有七百位醫生所開的處方可能有害 (2)

Report: 700 doctors wrote possibly harmful Medicare prescriptions

據報導：有七百位醫生所開的健保處方可能有害 (2)

The cost to the government was enormous in some instances. Medicare paid $9.7 million for the prescriptions of one California doctor alone — that is 151 times more than the cost of an average doctor’s tally, the report says.

報告又說在某些情形中，政府的負担是很大的。光以某一位加州的醫師而言，老人健保局就付了玖佰柒拾萬元的處方药費用，換言之，那是比每一平均醫師身價的151倍還多的費用。

Most of this physician’s drugs were supplied by two pharmacies, both of which the inspector general had identified previously as having questionable billing practices.

這位醫師大部分的藥是由兩家藥局供應，檢查長事前就辨識出，這兩家是有令人懷疑的作帳習慣

All told, the drugs ordered by the doctors labeled extreme outliers cost Medicare $352 million, the report says.

總之，報告說這些被醫師開的藥，被標名為極偏的外圍醫共花了健保局3億5仟2佰萬元。

Although some of this may have been appropriate, the report says, “prescribing high amounts on any of these measures may indicate that a physician is prescribing drugs which are not medically necessary or that he or she has an inappropriate incentive, such as a kickback, to order certain drugs.”

報告說，雖然此事的某此些部分也許是適當的，但根據這措施的任何一項，開出高量的處方，也許顯示醫師開的並非是醫療上必要的，或醫師有不正當的出發點或動機，例如想收回扣。

Sen. Tom Coburn (Okla.), the ranking Republican on Carper’s committee, said no one wants Medicare to tell doctors which drugs to prescribe. But the government does have a responsibility in preventing fraud and abuse, he said.

奧克拉荷馬州選出的参議員Tom Coburn，他是在卡波委員會裡居領導地位的共和黨黨員，他說，沒有人要健保局告訴醫生該開什麽藥。但政府的確有責任防止醫師的欺騙與濫用醫師的權利。

Medicare officials “should be using their data to make sure those practicing medicine are practicing medicine and not practicing a sham,” said Coburn, who is an obstetrician.

『健保局官員，應該利用資科來確信，執業醫師是在正當行醫而非使用詐欺手段」』一位名叫Coburn的產科醫師說。

The inspector general’s report calls on the Centers for Medicare and Medicaid Services (CMS), which oversees the program, to step up scrutiny of doctors with questionable prescribing patterns. It urged CMS to direct its fraud contractor to expand its analysis of prescribers and train the private insurers that administer Part D on how to spot problem prescribers.

檢查長的報告請求CMS (專門負責監管此計劃的健保局與健康補助局中心) 要設立對具有可疑處方型式的醫師，進行詳察的工作。報告鼓勵CMS指導它偵查欺騙行為的包商，來擴大分析處方者，並訓練執行Part D (藥物保險) 的私人保險公司，如何來偵查有問題的處方者。

Medicare also should send doctors report cards comparing their prescribing to that of their peers, the report says.

報告說，健保局也應將報告卡送給醫師們，將他們的處方與他們的同輩醫師作一個比較。

In a response to the inspector general, the Medicare agency wrote that it agrees with the recommendations, has been working to reduce overuse of narcotics and plans to expand its use of data to flag questionable prescribing.

在回應檢查長的報告中，健保局提出說明：

一、該局同意檢查長的建議。二、他們一直進行減少麻醉藥品的過度使用。三、計劃擴大使用資料來標示有疑問的處方。

“We must balance these efforts with ensuring that beneficiaries have access to the medicines they need,” a CMS spokesman said Wednesday in a statement.

一位CMS發言人在星期三的聲明中說，『我們必須在這些努力與確信保險受益人，可以方便服用他們需要的藥物，兩者之間取得平衡點。』

For its investigation, ProPublica analyzed four years of Medicare prescription drug data and examined the prescriptions of all health professionals across specialties. It looked at all prescribers — 1.7 million in 2010 alone — not just those in general-care specialties or mostly urban areas.

為它的調查，ProPublica分析了健保局四年中的處方藥品資料，並審視了所有跨越專業醫師的醫療人員的處方。它們詳閱了所有開方者-光是2010年就有170萬人，不僅是一般科的醫療專家，或大部分在城市地區執業的醫師。

The new report from the inspector general is the latest to find oversight problems in Part D. Previous reports found that insurers have paid for prescriptions from doctors who were barred by Medicare or whose identities were unknown to insurers or Medicare.

由檢查長所提出的新報告是，最新的發現，找到了在藥品保險Part D項中的被監督的問題。以前的報告發現，保險業者為被未受健保局所採用的醫生，所開的處方支付了費用，而這些醫生的身份保險業者或健保局均不認識。

Coburn said Medicare has been warned repeatedly that it was not properly overseeing the program.

Coburn說健保局一再被警告說，它們未善盡監管工作。

“This is incompetency and lack of somebody being held accountable,” he said. “It’s fixable.”

『這是未能勝任與缺少負責的人』，他說，『這是可以改正解決的事。』(待續)

 

Justin Lai, 07/06/2013

Jlai77168@gmail.com

chiayihischool@gmail.com

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